City of Edinburgh Council - Care Management Team / BBV Housing Support Service Care Management Team BBV The Bonnington Centre 200 Bonnington Road

Transcription

1 City of Edinburgh Council - Care Management Team / BBV Housing Support Service Care Management Team BBV The Bonnington Centre 200 Bonnington Road Edinburgh Edinburgh EH6 5NL Telephone: Inspected by: Helen Eagle Type of inspection: Announced (Short Notice) Inspection completed on: 1 July 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: City of Edinburgh Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Helen Eagle Telephone enquiries@careinspectorate.com City of Edinburgh Council - Care Management Team / BBV, page 2 of 24

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The Care Management Team was multi-disciplinary and led by a Manager and Senior Social Worker. The service provided an expert assessment, care management and a housing support service. Staff were qualified and highly experienced, with specialist knowledge in BBV and a commitment to this client group. The team's contribution to people's health and wellbeing was excellent. People using this service told us they valued the support they received. We heard that many people returned to the service when their circumstances changed, requesting additional support. Managers and staff recognised and valued the opportunity to make a difference to people's lives. What the service could do better Whilst there had been widescale consultation about the future of BBV services in Edinburgh, managers acknowledged that there could be more opportunities for people to influence improvements to this service. A Departmental review of adult services was underway which meant that future ways of working were likely to change. Some staff expressed concern about the future of specialist BBV services and about their own future role. There was a proposal for a housing allocation panel, to ensure that decisions were fair and transparent. City of Edinburgh Council - Care Management Team / BBV, page 3 of 24

4 What the service has done since the last inspection A review of all the adult resource services was underway. Staff had been given opportunities to comment. There were more ways for people to participate, have a voice and influence the development of services. These included a service user forum, social events, peer support groups, conference attendance, training opportunities. In 2012 post case closure reviews were introduced to evaluate the outcomes for the service user, and to consider any issues to improve the service. Conclusion The service delivered a very good quality service. Who did this inspection Helen Eagle City of Edinburgh Council - Care Management Team / BBV, page 4 of 24

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations. If we are concerned about some aspect of a service, or think it could do more to improve, we may make a recommendation or requirement. * A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. * A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. The Care Management Team - BBV provides a housing support service to vulnerable adults throughout the Edinburgh area, who face additional challenges because of HIV and/or Hepatitis C. The service is provided by the City of Edinburgh Council Health and Social Care Department. The service works with a number of landlords and professionals to provide suitable accommodation and a range of social, emotional and practical support to assist service users manage their tenancies and maintain their health and welfare. This includes help with practical tasks, enabling access to other health, social, advisory and advocacy services. The service states that it has at its core the Social Work values of: City of Edinburgh Council - Care Management Team / BBV, page 5 of 24

6 "Protecting the rights and promoting the interests of service users. Striving to establish and maintain the trust and confidence of service users and carers. Promoting the independence of service users while protecting them as far as possible from danger or harm. Respecting the rights of service users while protecting them whilst seeking to ensure that their behaviour does not harm themselves or other people. Upholding public trust and confidence in social services. Being accountable for their practice and taking responsibility for maintaining and improving knowledge and skills." Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. City of Edinburgh Council - Care Management Team / BBV, page 6 of 24

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This report was written by Helen Eagle, Inspector, following five visits to the service, on 5, 13, 18, 19, 25 June Feedback was shared with managers on 1 July Prior to the inspection we asked the service to distribute Care Standards Questionnaires to people receiving housing support. We received 15 responses (of 23). During the inspection visits we gathered evidence from various sources, including: * Discussion with 3 people using the service, * Observation of staff interactions with people using the service, * Discussion with the Manager and Senior Social Worker, * Attendance at a team meeting and individual discussion with staff members, * Observation of a planning meeting involving the team, the tenancy officer and a colleague from the residential rehabilitation team, * The service's annual return and self assessment, * Electronic records, assessments, support plans, * Evidence of consultation and participation. We took all of this evidence into consideration when writing this report. We also took into account the Public Services Reform (Scotland) Act 2010 and its associated statutory instruments, the National Care Standards Housing Support Services, and the Scottish Social Services Council (SSSC) Codes of Practice for Social Service Workers and Employers. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. City of Edinburgh Council - Care Management Team / BBV, page 7 of 24

8 Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at City of Edinburgh Council - Care Management Team / BBV, page 8 of 24

9 What the service has done to meet any recommendations we made at our last inspection We made one recommendation at the previous inspection. 1. The service should continue building a range of opportunities to encourage and support people to have a say in the way the service is provided and developed. There should be comprehensive evidence of opportunities and the outcomes for people. This was in accordance with the National Care Standards Care Housing Support Services: Standard 8 - Expressing Your Views and the Scottish Social Services Council (SSSC) Codes of Practice for Social Service Workers Sections 1.1, 1.2, 1.3 and 3.1. See comments in Quality Statement 1.1. This recommendation was met. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the service provider. We were satisfied with the way in which the service provided had completed this and with the relevant information they had given us for each of the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. The grades we awarded for this inspection were the same or higher than those suggested by the service in the self assessment. City of Edinburgh Council - Care Management Team / BBV, page 9 of 24

10 Taking the views of people using the care service into account We asked the service to distribute Care Standards Questionnaires to its service users. Twenty three issued. We received 15 completed questionnaires. Our analysis of the 15 responses showed that: Inspection report continued 100% were happy overall with the quality of their support, 100% said staff treated them with respect, 100% knew the names of the staff supporting them, 100% were confident that staff had the skills to support them, 3 people did not know if they had a personal support plan, 3 people said staff did not have enough time to carry out the agreed support, 1 person said the service did not check with them regularly that they were meeting their needs, 7 people said the service had not asked for their opinion about how it could improve, 5 people did not know about the service's complaints procedure, 6 people did not know they could also make a complaint to the Care Inspectorate. Comments included: "I cannot thank the service providers enough, as they have been fantastic with the support they have provided. I'd be truly lost without them." "(name) my care worker has been a great help while she has been my case worker. Great support and has remained professional at all times. I owe her a lot as without times would have been harder." "Due to time constraints I feel that the support is not as regular as I would like." "Without the team I do not know where I would be now. I have gone from being a homeless, active alcoholic and drug abuser, suicidal depressive to being settled in a beautiful flat, my addictions beaten due to a referral from (named staff) for the LEAP treatment programme, living a good and optimistic life. I feel that (three staff member names) have gone beyond their professional duties to get me to where I am now, and I don't have the words to fully express how grateful I am to them and the team. Thank you!!" "I have 2 support workers. They are both great at their jobs, nothing is too much trouble for them. Couldn't cope with life without them. It always cheers me up when we meet." City of Edinburgh Council - Care Management Team / BBV, page 10 of 24

11 "I want whoever reads this to let them know I don't know what or where I'd be if I didn't have the care that I receive from the service. All staff have been kind and supportive to me in helping me stay in my home and that I'm so safe and settled." "Just I can say "Thanks", I received enough support from your office, and was, is and will be a "blessing". One year ago I never thought that your staff could achieve a total change in my life. Many thanks and God bless you for all!" "I am in a supported flat, but at present don't have a worker assigned". "Anything that I am unsure about I contact my worker by telephone and they will help me deal with the problems. For example, benefits, appointments." "I would just like to say thank you all for the help to make living with all my health and mental problems. I don't think I could have ever really made it work by myself but with the help and support of my worker (name) and others on that team I am still here today due to the support from them and I hope stay about for a good few years yet. Thank you for the help and support throughout the years." "Would like to have more frequent contact but due to time constraints this is happening less and less, I feel that my mood suffers when I do not see my support worker." Taking carers' views into account We did not seek the views of relatives for this inspection. City of Edinburgh Council - Care Management Team / BBV, page 11 of 24

12 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We saw the service had developed very good opportunities for people to participate in assessing and improving the quality of support. We heard that senior managers had been persuaded of the value of participation. Managers and staff encouraged people to have a voice. There was a Consultation and Engagement Strategy (CEC - Health and Social Care Department). The National Standards for Community Engagement had been adopted as a basis for good practice in service user involvement. There was a Development Officer for service user involvement. Participation activities and training opportunities included: A service user forum which met twice a month, with representatives from across the adult/substance misuse services, A new peer support group, with a recovery focus, A new volunteer peer mentoring project which had secured funding and senior management support, Opportunities for volunteers to be supported to achieve a new Professional Development Award (PDA) in mental health peer support - offered by Edinburgh College, commencing in Information sessions for service users, Consultation about future BBV provision including respite care, which included invitation to two events, Local, regional and national opportunities, for instance conferences and consultations and working groups, City of Edinburgh Council - Care Management Team / BBV, page 12 of 24

13 Involvement in social worker training and learning, A Forum representative on the self directed support and personalisation working group, A dedicated recovery Christmas Tree at a local Festival for service users and families. People attached decorations/dedications and could add their thoughts about what recovery meant to them. We heard that this had been a very powerful exercise. A Christmas coffee and mince pie social event for staff and service users. The service had a brochure describing the service on offer and the referral process. We saw a new, plain language brochure had been added, which had been developed with service users. There was information about working with health professionals, housing, the Care Inspectorate, translation. The service had raised its profile with potential service users through leaflets and increasing its visibility at clinics across the city. People referred to the service were offered a detailed assessment (carenap). This was carried out by care managers who were experienced and skilled and could fully explore the person's needs and explain what could be provided. All of the information gathered was used to develop a personal support plan, to meet the identified and agreed needs. Support plans were signed by each service user and people were offered a copy of their plan. Each service user had a named member of staff who provided their support. Most people also knew other members of the team. Managers occasionally met service users before the service commenced and usually had some contact thereafter, such as when providing covering for staff absence, when people visited the office, through meetings, social events and reviews. People were asked to consent for information to be shared with other professionals. The reasons for this were explained (such as to avoid duplication, to speed up processes), as was their right to refuse to consent. People were informed that their support could change or stop at any time. People were involved in reviewing their support at least every six months. People could comment on their named worker and the work of the team. We saw that support plans were up-dated regularly. The service carried out periodic surveys using questionnaires. Inspection report continued People were given information about how to raise a concern or make a complaint about the service. We saw a new leaflet and free-post complaint form on display in the service's office. City of Edinburgh Council - Care Management Team / BBV, page 13 of 24

14 We saw that complaints were responded to and actions were taken to rectify any areas for improvement. People were supported to make contact with other agencies, such as advocacy services. The service carried out "closed case" reviews, where the outcomes for people who had used the service were evaluated and any improvements to the service were considered. Copies of inspection reports were available to all service users. Areas for improvement Managers confirmed that they knew a few service users felt they did not receive as much contact as they would like. For the responses to the Care Standards Questionnaire we saw three people did not know if they had a support plan. Five people did not know how make a complaint about the service. Six did not know how to complain to the Care Inspectorate. The service was encouraged to regularly promote its comments/complaints system and also remind people of the role of the Care Inspectorate. Managers recognised that more ways were needed to capture the views of people who do not attend meetings or fill in surveys/questionnaires. In order to maintain or improve the grade awarded the service should continue building opportunities for people to influence the quality of the service. Progress in these areas will be monitored at the next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We saw that there were excellent systems to ensure that people's health and wellbeing needs were met. There was a comprehensive face to face assessment where people's needs were fully explored. This included an assessment of risk. We heard that people had multiple and City of Edinburgh Council - Care Management Team / BBV, page 14 of 24

15 complex physical, psychological and psychiatric issues and needs. Some service users also experienced stigma attached to their lifestyles, their medical condition and their mental health problems. Service users were offered a focused care management service for a period of months. The team had a Property Officer who liaised with housing providers. People were consulted about where they want to live. This was especially important as some people needed to be near family or a particular community for support. Others needed to make a fresh start away from former associates or areas. Nominations were made to Housing Associations for a tenancy. The Property Officer made arrangements for furnishings and refurbishments. People had a degree of choice over carpets, curtains and decor for their properties. We heard that the service was careful to avoid any financial disincentives for people to seek work. Staff had a checklist of things to do with any new property, such as checking meter readings, making sure agencies knew of the change of address. People could move tenancy if their circumstances changes and they were reassessed. For example if there were safety concerns. The service offered in depth counseling to address major life issues, for example loss, separation and abandonment, trans gender issues, sexual abuse, being in the care system, alcohol and drug misuse. The staff were aware of and supported people to address issues that caused barriers to accessing treatment or support. We heard that people could be confident in disclosing painful aspects of their past with staff. Staff had excellent knowledge of the health needs and challenges for the client group in this specialist service. For example, we heard about the advances in treatment for people with HIV and the particular challenges of treatment programmes. Staff could support people to prepare for treatment and to make and attend health care appointments. We heard how staff helped people to understand and take on board some of the medical information and advice they had been given. The service was responding to emerging needs, for instance the needs of older people with HIV; people using legal highs who experience devastating consequences. Members of the team held specialist roles and worked in multi-disciplinary settings, ensuring that the latest knowledge was brought back to the team. Service users were supported to explore opportunities for meaningful occupation such as volunteering or college. Some people were beginning to look at the possibility of there being a chance to fulfill lifelong ambitions. We heard that people had been supported to start to find employment. City of Edinburgh Council - Care Management Team / BBV, page 15 of 24

16 We observed a planning meeting involving the team, the Property Officer and a colleague from the residential rehabilitation team. Staff made thorough, considered preparations to ensure a person's smooth transition back into a tenancy/ the community. Time was taken to explore every aspect and any potential pitfalls. Plans included detailed arrangements for transport from the train station to the new accommodation, start up tenancy needs, immediate needs for refreshments and bedding, exploring the local area, safety. As the service user had a child there was built in liaison with social work colleagues, arrangements to visit a local school. The planning was designed to get it right for the service user and for the child. We observed respectful interactions between staff and people using the service. People confirmed, in their Care Standards Questionnaire responses, that staff were respectful and skilled. Managers and staff spoke of successful outcomes for service users. We found that the quality of the relationship between staff and service users contributed to this. The service reported on the outcomes for people. Areas for improvement The service should continue to ensure the excellent focus on people's health and wellbeing. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued City of Edinburgh Council - Care Management Team / BBV, page 16 of 24

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Comments in Quality Statement 1.1 also apply. The service had a small staff team and there was low turnover of staff. Staff confirmed that managers observed their practice on a regular basis, for example at review meetings, when service users visited the office, at forum events. There were opportunities for service users to raise concerns about staff at review meetings, by telephone, through surveys, through the complaints system. It was possible for service users to request a change of worker. Where service users needs identified gaps in team knowledge, training was sought. For example, working with people who have autism; working with victims of criminal assault; working with adult survivors of childhood sexual abuse; working with families where there is substance misuse. Areas for improvement There were plans to recruit a new member of staff to fill one vacancy. In order to maintain this grade the service should offer service users' opportunities to participate in this process, for example: involvement in preparing the job description/person specification, short listing, interviewing, induction training, probationary evaluation, performance review. Progress in these areas will be monitored at the next inspection. City of Edinburgh Council - Care Management Team / BBV, page 17 of 24

18 Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued Most staff held professional qualifications in social work, nursing or community education, or were being supported to achieve this. The Manager, Senior Social Worker and all Social Workers were registered with the Scottish Social Services Council (SSSC). One member of the team was registered with the Nursing and Midwifery Council. All staff adhered to the National Care Standards and SSSC Codes of Practice. Managers and staff had extensive experience in their specialist field and most were long serving members of staff. From observation and discussion, staff members demonstrated a commitment to the client group and a high level of knowledge and expertise. The team had good external networks, all team members worked closely with health colleagues and some also worked within hospital based multi-disciplinary teams. All of the staff had access to the Provider's intra-net, providing them with organisational policies and procedures and news. Staff had links to national practitioner forums to keep up to date with good practice. New staff received a Council induction and a local induction with managers. This included time with the specialist HIV and the Hepatitis C workers at the Regional infectious Diseases Unit. There was also an introduction to the other adult resource teams - supporting people with drug and alcohol problems and people referred to residential rehabilitation. New staff would also visit key partner services, such as Milestone House (respite). There were good training opportunities, for instance one worker was being supported through a Social Work degree with the Open University. Other training and conferences could be requested, usually these were directly related to the health needs of the client group. Training opportunities were advertised through the Council's Orb intra-net. Recently some team members had attended a seminar on ethics. Other training included: welfare benefits; appropriate adult; motivational interviewing; mental health; adult protection level II and III; child protection. We saw there were fortnightly team meetings, where new service users' needs were discussed and work was allocated to team members. There were monthly practitioner City of Edinburgh Council - Care Management Team / BBV, page 18 of 24

19 meetings where staff could raise practice issues. Team development days were held approximately twice a year. There were systems for staff supervision and performance review. Managers expressed confidence in staff members. Staff were experienced in taking a lead role, for example in discussions with other teams or agencies; dealing with emergencies. Staff were supported to take initiative and responsibility for their practice. Staff members could work in pairs or jointly should this be necessary. We heard this worked well for service users and for staff. Staff said there was good management support. For example, counselling and support from a trauma service had been accessed for staff. We heard there was good team work and good links with the other adults team. There was a lone working policy. Staff confirmed that they returned to or called the office at the end of their day. Staff felt that they made a difference to people's lives. We saw that there were high standards of professionalism and accountability in the service. Areas for improvement We identified some issues which had an impact on team member's motivation: * Supporting people with changes in benefit entitlements, including under occupancy, was dominating current work. This was necessary, but under utilised staff member's skills. * A perceived inequality in workloads. * The on-going service review meant uncertainty about future roles and career progression. * The emphasis on short term work allowed less opportunity to build therapeutic relationships. We suggested that the team should explore how best to continue supporting colleagues dealing with disturbing/traumatising situations. Progress in these areas will be monitored a future inspections. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued City of Edinburgh Council - Care Management Team / BBV, page 19 of 24

20 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Comments in Quality Statement 1.1 and 3.1 apply. We have applied the same grade to this Quality Statement. Areas for improvement From the Care Standards Questionnaire responses, six people said they had not been asked about how the service could improve. The Manager acknowledged that this was an area for development. In order to maintain this grade the service should continue building opportunities for people to influence the management and leadership of this service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths The Health and Social Care Department's Quality Assurance Team supported teams and managers to ensure the delivery of quality services. The Care Management Team had a yearly plan, which set out its objectives. There was an Outcomes based audit tool to measure the performance of the service. A strategic review was underway, looking at efficiency savings and changes to the service structure and delivery. Staff had been consulted and had chosen a preferred City of Edinburgh Council - Care Management Team / BBV, page 20 of 24

21 model. We heard that service users would be given the opportunity to comment before a senior management decision was taken. Service users had been consulted on the future of HIV respite services and the implementation of Hep C policy and procedures. The service responded to changing conditions and policy in the field of HIV and Hepatitis C such as NHS Lothian's HIV and Sexual Health Strategy and the Managed Care Network services for people with Hepatitis C. Audits of files and support plans took place during staff supervision, to ensure that record keeping was up to date and of a high calibre. Accidents, incidents and complaints were recorded and followed up appropriately. We saw that managers were in touch with the day to day issues for staff and well aware of the successes and the challenges of their work. Management meetings were recorded and shared with senior management. For instance: the significant effect of welfare reform and voluntary sector funding cuts on service users (anxiety, stress, anger). There was an impact on the amount of time staff were spending on benefits issues. In 2012 post case closure reviews were introduced to evaluate the outcomes for the service user, and to consider any issues to improve the service. Areas for improvement Record keeping systems were mostly electronic. Staff expressed frustration with IT constraints, such as systems that did not connect with each other requiring them to input information twice, occasional shortage of hot desks for staff to access computers, lack of scanning facilities. This had an impact on the amount of time staff had to spend with people. We welcomed the proposal for a housing allocation panel, to ensure that decisions were fair and transparent. Progress in these areas will be monitored at the next inspection. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued City of Edinburgh Council - Care Management Team / BBV, page 21 of 24

22 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). City of Edinburgh Council - Care Management Team / BBV, page 22 of 24

23 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Very Good 6 - Excellent Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 12 Dec 2011 Unannounced Care and support 4 - Good Staffing Not Assessed Management and Leadership 4 - Good 23 Mar 2010 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 24 Feb 2009 Announced Care and support 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. City of Edinburgh Council - Care Management Team / BBV, page 23 of 24

24 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: City of Edinburgh Council - Care Management Team / BBV, page 24 of 24